The story of living in spite of melanoma, metastasis, vaccines, anti-PD-1, lung removal, and stereotactic radiation. The story of life with family and friends. {Posts under ~ Sew Chaotically, Travel Chaotically, and Chaotic Cookery also housed within! A girl's gotta have fun!}

About Me

Who am I? That is a question the rest of you could probably answer better than I. I am a wife, mother, daughter, sister, friend, pediatric nurse practitioner, cook, teacher, gardener, lover of words and music, occasional seamstress, and homemaker. I do have a couple of talents of questionable merit: I can create a decent meal in less than 30 minutes. I can feed and/or soothe almost any baby. And I can remember practically any song I've ever heard. For the rest, I'd rather those who know me decide.

Sunday, May 8, 2016

CAVATAK - intralesional therapy derived from the coxsackievirus

Many intralesional therapies, medicine that is injected directly into a tumor, have been found to have some success in melanoma. We have learned that, at times, they can not only kill the tumor into which they are injected, but "by-stander" tumors as well. First tried in 1975 with the BCG vaccine, things as disparate as IL2, Allovectin-7 (a DNA mixture), T-VEC/OncoVEX (derived from the herpes virus), L19, PV-10 (from the dye Rose Bengal), GM-CSF, and CAVATAK (derived from the coxsackievirus) have been used. Additionally, some of these intralesionals have been tested combined with systemic immunotherapy. The idea being that one could prime an immune response by injecting a
tumor with an oncolytic virus, eliciting a T-cell influx, and follow
with systemic immunotherapy.

"CVA21
is a novel bio-selected oncolytic and immunotherapeutic strain of
Coxsackievirus A21. Intratumal injection initiates preferential tumor
cell infection, cell lysis [death] and enhancement of a systemic
anti-tumor immune response. The CALM study looked at 57 patients with
treated or untreated, unresectable Stage IIIC-IV melanoma. Patients
were given injections on study days 1, 3, 5, 8, and 22, then every 3
weeks for a further 6 injections. Patients showing immune-related
progression-free survival or better at 6 months were eligible for 9
additional injections. RESULTS: 21 of 57 (38%) patients
displayed progression free survival at 6 months with median PFS of 4.2
months. Overall response rate was 28% (16 of 57) with a more than 6
month durable response rate of 19% (11 of 57). Median time to response
was 2.8 months, 1 year survival rate was 75% (43 of 57 patients). At
more than 16 months, median duration of response in responders and
median overall survival for all patients was not yet reached. Most
common side effects = Grade 1 fatigue, chills, local injection site
reaction, and fever. No grade 3 or 4 reactions. Further studies with
CVA21 in combination with other immunotherapies are in process."

And this link/synopsis of Weber's "What's new in 2016" talk...discusses what's coming and recent in melanoma care as well as CALM results: Immunology update webinar for melanoma
Within...this blurb is included:

Here is a link to: Intratumoral CAVATAK and ipi trial
Apparently folks will get ipi at 3mg/kg 4 times. You have to have an injectable tumor (per their criteria) and CAVATAK will be injected 4 specific times and then every three weeks for up to one year. The study is a Phase 1 trial, sponsored by Viralytics and was started in late 2014. You can't have taken ipi for metastatic melanoma, but you can have taken it as an adjuvant as long as you did not experience a grade 3 toxicity. Trial is recruiting in California, Oregon and Illinois.

CAVATAK is also being studied in bladder cancer and non-small-cell lung cancer. There is also a study combining CAVATAK with pembro for melanoma. Here's the link: Intratumoral cavatak and pembro trial Here folks will get CAVATAK injections at specific times up to 19 total injections into "at least one cutaneous, subcutaneous tumor or palpable lymph node amenable to intratumoral injection" and pembro infusions every 3 weeks up to 2 years. Exclusions include: no corticosteriods, ocular or mucosal melanoma. No prior anti-PD1 or PDL1. Also sponsored by Viralytics, recruiting in New Jersey.

Guess that's about all I got. I have always been a fan of intralesional therapy...telling B that if I ever recur...and have to have some sort of surgery...I was going to beg to have Rose Bengal and lord knows what else...just splashed around in there before they sew me up. Those who know B can imagine the big blue eye roll that comment gets me....but there you go!!! Love you, Josh! - c